Journal of Clinical Oncology, Vol 10, 334-342, Copyright © 1992 by American Society of Clinical Oncology
Combination chemotherapy versus melphalan and prednisolone in the treatment of multiple myeloma: an overview of published trials
WM Gregory, MA Richards and JS Malpas
Imperial Cancer Research Fund Clinical Oncology Unit, Guy's Hospital, London, England.
PURPOSE: A meta-analysis was performed to compare survival after treatment
with melphalan and prednisolone (M + P) with that after combination
chemotherapy (CCT) in patients with multiple myeloma. METHODS:
Meta-analysis was performed on 18 published trials comprising 3,814
patients comparing M + P with CCT. Two-year survival percentages with
observed and expected deaths at 2 years were calculated for each trial, and
the overview methodology was applied to these figures. RESULTS: Overall
results from the 18 trials suggest that there is no difference in efficacy
between the two treatments. This finding, however, masks a highly
significant correlation between 2-year survival rates for M + P-treated
patients in individual studies and the difference between the M + P and CCT
2-year survival rates for that study (r = .69; P = .0008). In separate
overviews, those studies with a high M + P 2-year survival rate showed a
survival difference in favor of M + P (P = .02), whereas those with a low
rate suggested a difference in favor of CCT (P V .07). Comparison of the
2-year survival rates in the M + P treatment arms of each of the studies
with available data showed an inverse correlation between survival and the
proportion of patients with either poor performance status (P less than
.001) or immunoglobulin A (IgA) M band (P = .02). CONCLUSIONS: These
results imply that M + P is superior for patients with an intrinsically
good prognosis and inferior for those patients with a poor prognosis. If
reliable prognostic factors can be established for this disease, they could
be used to select therapy for individual patients.
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